The best treatment for flaky facial skin is a common question I answer, especially from my dermatology patients who suffer from facial dandruff and rosacea. I received this exact question from a reader recently and wanted to share my response.
Hello Dr. Bailey, I just love your newsletter and blog posts; I have learned so very much from you. I have had rosacea for at least 15 years. I have been on the sulfacetamide lotion, Metrogel, and Finacea gel. I had stopped using the sulfacetamide lotion for 2 years. I thought my rosacea was getting better. This year I was diagnosed with seborrheic dermatitis (facial dandruff) on my face out of the clear blue.
My dermatologist put me on a Noble Zinc Soap, sulfacetamide lotion (night & morning), ketoconazole cream at night, and Finacea Gel in the morning. Since reading your blog I now use the Green Tea Antioxidant Skin Therapy Cream. What a beautiful cream and what a difference it has made in my skin. I also bought the Advanced Corrective Eye Cream because of your review on it, and what an anti-aging difference that has made.
My questions are,
I think that the Finacea is slightly drying my face.
I use it first before the Green Tea because I like to use the Green Tea as my moisturizer.
- Do you think I should stop using the Finacea?
- Is it bad for my seb dermatitis, because I still see the dry skin around my nose area a bit?
- Could the Finacea be preventing a total clear up of the facial dandruff?
I was just thinking of using the zinc soap, the sulfacetamide lotion and the Green Tea Cream. Thank you very much for your help! Laura B.
Hello Laura, Thank you for your kind words about my blog and newsletter; I'm glad you've found helpful information here. I can give you general information about how I handle this combination of skin problems in my practice. You can discuss this information with your dermatologist.
Dandruff and Rosacea Flaky Skin is a Common Face Problem
Both rosacea and facial dandruff (seborrheic dermatitis) cause rashes (called dermatitis) that result in red flaking facial skin. Of the two skin problems, the facial dandruff is more likely to cause flaking in the creases of the nose.
What's really important to know is that the rashes from both facial dandruff and rosacea cause a compromise to your skin barrier integrity and make your skin really sensitive.
This means that the involved skin is very easily irritated by harsh products. It's also more sensitive to harsh climactic conditions or strong skin cleansers.
Seborrheic dermatitis (facial dandruff) and rosacea skin problems often coexist.
You certainly have experienced this! They can also flare up together, or one can be worse than the other at any given time. I tell my patients who suffer from this frustrating combination of skin problems, when either of these conditions has become persistent then we need to protect the involved skin from everything that is irritating. This allows the rash to subside so that the skin barrier integrity can be repaired. The process requires applying only non-irritating products to the skin so it can recover. I call this a Rosacea or Seborrheic Dermatitis Cool-Down.
This "cool-down" skincare routine is important because applying irritating products to barrier-compromised skin is like squeezing lemon juice on a cut, meaning it prolongs inflammation and slows healing. Healing of the compromised skin barrier is supported by the using only bland moisturizers and soothing products. - Dermatologist Dr. Cynthia Bailey
In my experience, Finacea can be irritating to some skin types.
There is individual variation in terms of product tolerance and I always ask patients what products their skin tolerates and what products it doesn't. Finacea contains 15% azelaic acid, an ingredient than can irritate barrier compromised complexion. For the "cool down" we use only products their skin tolerates well.
Dermatologist Dr. Bailey's Rosacea or Facial Dandruff Cool-Down Skin Care Routine
Twice daily, cleanse flaky and sensitive facial skin with one of the following cleansers (they can be alternated depending on skin tolerance and need):
A pH balanced soap free cleanser.
My top choice is my Extremely Gentle Foaming Facial Cleanser (this is what I personally use for my sensitive rosacea and seborrhea prone skin). Another option is Toleriane Cleanser (the least irritating option)
This is the best pyrithione zinc natural bar soap because it is made with shea butter. I much prefer this to Noble Zinc or any other similar product. Shea butter is complex and very beneficial for skin. It contains a high concentration of anti-inflammatory and antioxidant compounds that help heal irritated flaky skin. I developed this recipe and many thousands of patients and customers have found this pyrithione zinc bar soap singularly beneficial for their rosacea and seborrhea.
Wow! This soap is amazing! I have struggled with rosacea for years. Even using oral antibiotics. Since using this soap, I no longer have to use the oral medication. CM
I'm 65 years old and have finally found the answer to the scales, redness and flakey skin between my eyebrows. I had tried countless remedies, with no results, until I discovered the Calming Zinc Bar. I can't overstate how awesome this product is. Since starting to use it about a year ago, I have had NO flakes, scales or redness at all...nothing but clear skin in my eyebrow area. I still can't believe how completely and quickly it worked! My only regret is that I didn't discover it 25 years ago. The bars last a long time, making them affordable, as well. Thank you, Cynthia Bailey. I've never been more impressed with a facial product!! Debbie B
Sodium Sulfacetamide Prescription Cleanser
The latter two products can dry or irritate some people so the question of skin tolerance is important in picking which cleansers we use for the cool down. It appears that you have been on a lotion that contained this ingredient. Prescription facial cleansers are also available.
What cream is best for flaky facial skin from rosacea and seborrhea?
After cleansing, I have my patients apply in this order:
- Green Tea Antioxidant Skin Therapy because the skin's antioxidant reserve is stressed by inflammation. I believe the antioxidant replenishment is one of the main reasons that the Green Tea Antioxidant Skin Therapy makes such a big difference for healing facial dandruff and rosacea. I have my patients apply it first before applying other products.
- Clotrimazole cream to calm seborrheic dermatitis where it has been flaring up.
- A soothing moisturizer to all of the facial skin that feels like it needs a richer moisturize. This is important because barrier compromised skin needs ingredients that help heal the skin barrier (called the stratum corneum). My top choice is one of my hypoallergenic and barrier healing Daily Moisturizing Face Creams. Get this together with Green Tea Antioxidant Skin Therapy and Calming Zinc in my Facial Flaking and Redness Solution Kit.
I highly recommend my Facial Flaking and Redness Solution Kit for anyone suffering from both rosacea and seborrhea.
My Seborrhea and Rosacea Cool-Down Skin Care Routines also may include:
- Prescription medicaments that are non-irritating to treat rosacea or seb derm, if necessary (e.g. Cleocin Lotion, Sodium Sulfacetamide Lotion, Metrogel, or Metro Cream and occasionally permethrin cream, all according to their dosage requirements). I usually have my patients apply these after the Green Tea because products with lighter bases are often better applied before those with heavier bases.
- A very mild cortisone cream such as 1% hydrocortisone cream. I have them use this only where the rash is red, and for usually no more than 2 weeks. I, as my patient's treating physician, always supervise the use of this because there are side effects. I only use "non-halogenated" (a term a doctor will understand) cortisone products on the face.
- Pure mineral zinc oxide sun protection, because both of these skin conditions can flare-up from sun exposure. Pure mineral zinc oxide sunscreens that are non-irritating and perfect for sensitive (aka barrier compromised) skin. Find them on my Sun Protection page here.
I have my patients do this Cool-Down Skin Care Routine for 2 months, which is what is necessary to settle down skin inflammation. Stopping too soon results in relapse.
It takes a month or more for the skin barrier to heal AFTER the inflammation from rosacea and/or seborrhea has subsided.
This means that it is important to be patient and not to add irritating products back too soon. I hope that helps. Thanks for a really good question that I know other people share.
Cynthia Bailey MD, Board Certified Dermatologist
Why is Rosacea Considered to Be an inflammatory Disorder? The Primary Role, Clinical Relevance, and Therapeutic Correlations of Abnormal Innate Immune Response in Rosacea-Prone Skin. Del Rosso J Q et. al., J Drugs Dermatol. 2012;11(6):694-700.
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.